Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis

Objective: We aimed to develop an optimal protocol for failed mechanical thrombectomy (MT) in cases of emergent large vessel occlusion (ELVO) with intracranial atherosclerosis (ICAS). Methods: A total of 117 patients without underlying heart disease who were not taking antiplatelet drugs had early r...

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Autores principales:	Yun Ho Noh, Ji Young Lee, Seok Mann Yoon, Yu Jin Ha, Jaewoo Chung, Jung Ho Ko, Dong Seong Shin, Jae-Min Ahn, Hyuk Jin Oh, Jai-Joon Shim, Man Ryul Lee, Jae Sang Oh
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Ischemic stroke Intracranial arteriosclerosis Thrombectomy Thrombosis Tirofiban Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/47b0c407d9c94d2297294d7b6b882c0d
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spelling	oai:doaj.org-article:47b0c407d9c94d2297294d7b6b882c0d2021-11-30T04:16:09ZEfficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis2214-751910.1016/j.inat.2021.101425https://doaj.org/article/47b0c407d9c94d2297294d7b6b882c0d2022-03-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214751921003376https://doaj.org/toc/2214-7519Objective: We aimed to develop an optimal protocol for failed mechanical thrombectomy (MT) in cases of emergent large vessel occlusion (ELVO) with intracranial atherosclerosis (ICAS). Methods: A total of 117 patients without underlying heart disease who were not taking antiplatelet drugs had early reocclusion during MT for ELVO due to ICAS. They were divided into the following 3 groups according to rescue treatment methods: 1) Combined intravenous (IV) + intra-arterial (IA) tirofiban group (n = 48), emergent percutaneous transluminal angioplasty (PTA) and intracranial stenting (ICS) followed by IA injection of tirofiban and a continuous IV tirofiban infusion for 8 h; 2) IA tirofiban group (n = 33), only IA 0.5–1.0 mg tirofiban infusion for 5 min regardless of PTA or ICS; and 3) no tirofiban group (n = 36), no tirofiban injection regardless of PTA or ICS. Results: ICS was more frequently performed in the combined IV + IA tirofiban group than in the IA tirofiban group (100% vs 46%, p < 0.05). The proportion of m-TICI grades 2b and 3 (93.8% vs. 63.6%, p < 0.05), especially the proportion of m-TICI grade 3 (81.3% vs. 36.4%, p < 0.05), was higher in the combined IV + IA tirofiban group than in the IA tirofiban group. The rate of postoperative intracranial hemorrhage was not significantly different among the three groups. The rate of modified Rankin scale scores of 0–2 at 3 months after MT was highest in the combined IV + IA tirofiban group (63%), followed by the IA tirofiban (46%) and no tirofiban groups (8%, p < 0.05). Conclusion: ICS with IA and continuous IV tirofiban injections for 8 h is an effective and safe protocol for failed MT in patients with ELVO with ICAS.Yun Ho NohJi Young LeeSeok Mann YoonYu Jin HaJaewoo ChungJung Ho KoDong Seong ShinJae-Min AhnHyuk Jin OhJai-Joon ShimMan Ryul LeeJae Sang OhElsevierarticleIschemic strokeIntracranial arteriosclerosisThrombectomyThrombosisTirofibanSurgeryRD1-811Neurology. Diseases of the nervous systemRC346-429ENInterdisciplinary Neurosurgery, Vol 27, Iss , Pp 101425- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ischemic stroke Intracranial arteriosclerosis Thrombectomy Thrombosis Tirofiban Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Ischemic stroke Intracranial arteriosclerosis Thrombectomy Thrombosis Tirofiban Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429 Yun Ho Noh Ji Young Lee Seok Mann Yoon Yu Jin Ha Jaewoo Chung Jung Ho Ko Dong Seong Shin Jae-Min Ahn Hyuk Jin Oh Jai-Joon Shim Man Ryul Lee Jae Sang Oh Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
description	Objective: We aimed to develop an optimal protocol for failed mechanical thrombectomy (MT) in cases of emergent large vessel occlusion (ELVO) with intracranial atherosclerosis (ICAS). Methods: A total of 117 patients without underlying heart disease who were not taking antiplatelet drugs had early reocclusion during MT for ELVO due to ICAS. They were divided into the following 3 groups according to rescue treatment methods: 1) Combined intravenous (IV) + intra-arterial (IA) tirofiban group (n = 48), emergent percutaneous transluminal angioplasty (PTA) and intracranial stenting (ICS) followed by IA injection of tirofiban and a continuous IV tirofiban infusion for 8 h; 2) IA tirofiban group (n = 33), only IA 0.5–1.0 mg tirofiban infusion for 5 min regardless of PTA or ICS; and 3) no tirofiban group (n = 36), no tirofiban injection regardless of PTA or ICS. Results: ICS was more frequently performed in the combined IV + IA tirofiban group than in the IA tirofiban group (100% vs 46%, p < 0.05). The proportion of m-TICI grades 2b and 3 (93.8% vs. 63.6%, p < 0.05), especially the proportion of m-TICI grade 3 (81.3% vs. 36.4%, p < 0.05), was higher in the combined IV + IA tirofiban group than in the IA tirofiban group. The rate of postoperative intracranial hemorrhage was not significantly different among the three groups. The rate of modified Rankin scale scores of 0–2 at 3 months after MT was highest in the combined IV + IA tirofiban group (63%), followed by the IA tirofiban (46%) and no tirofiban groups (8%, p < 0.05). Conclusion: ICS with IA and continuous IV tirofiban injections for 8 h is an effective and safe protocol for failed MT in patients with ELVO with ICAS.
format	article
author	Yun Ho Noh Ji Young Lee Seok Mann Yoon Yu Jin Ha Jaewoo Chung Jung Ho Ko Dong Seong Shin Jae-Min Ahn Hyuk Jin Oh Jai-Joon Shim Man Ryul Lee Jae Sang Oh
author_facet	Yun Ho Noh Ji Young Lee Seok Mann Yoon Yu Jin Ha Jaewoo Chung Jung Ho Ko Dong Seong Shin Jae-Min Ahn Hyuk Jin Oh Jai-Joon Shim Man Ryul Lee Jae Sang Oh
author_sort	Yun Ho Noh
title	Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
title_short	Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
title_full	Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
title_fullStr	Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
title_full_unstemmed	Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
title_sort	efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/47b0c407d9c94d2297294d7b6b882c0d
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Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis

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